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WEEKEND MAINTENANCE: The maintenance outage is scheduled for June 22nd at 6:00am EST ending NLT Sunday, June 23rd at 11:59pm Eastern EST. The TRICARE Manuals web site may be available intermittently during this period but it's usage is not recommended.

TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Encounter Data (TED)
Chapter 2
Section 6.1
Non-Institutional Edit Requirements (ELN 000 - 099)
Revision:  C-54, September 16, 2021
ELEMENT NAME:  RECORD TYPE INDICATOR (2-001)
VALIDITY EDITS
2-001-01V
RECORD TYPE INDICATOR MUST =
2
NON-INSTITUTIONAL
Relational Edits
2-001-01R
IF TYPE OF SUBMISSION =
A
ADJUSTMENT OR
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
C
COMPLETE CANCELLATION OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
AND A MATCH IS FOUND ON THE DHA DATABASE
THEN THE RECORD TYPE FOR THE TED ON THE DATABASE MUST = THE RECORD TYPE ON THE ADJUSTMENT/CANCELLATION TED BEING SUBMITTED.
ELEMENT NAME:  FILING DATE (2-015)
VALIDITY EDITS
2-015-01V
MUST BE A VALID JULIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
2-015-01R
FILING DATE MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION (PTC)
ELEMENT NAME:  FILING STATE/COUNTRY CODE (2-020)
VALIDITY EDITS
2-020-01V
IF TYPE OF SUBMISSION =
D
COMPLETE DENIAL OR
I
INITIAL SUBMISSION OR
O
ZERO PAYMENT WITH 100% OHI/TPL OR
R
RESUBMISSION
THEN MUST BE A VALID STATE/COUNTRY CODE (REFER TO Addendums A AND B.)
Relational Edits
NONE
ELEMENT NAME:  SEQUENCE NUMBER (2-025)
VALIDITY EDITS
2-025-01V
SEQUENCE NUMBER MUST BE A COMBINATION OF ALPHABETIC OR NUMERIC CHARACTERS, LAST TWO CHARACTERS.
Relational Edits
NONE
ELEMENT NAME:  TIME STAMP (2-030)
VALIDITY EDITS
2-030-01V
MUST BE NUMERIC.
Relational Edits
2-030-01R
IF FILING DATE IS ≥ 02/01/1995
THEN TIME STAMP MUST BE > ZERO
ELEMENT NAME:  ADJUSTMENT KEY (2-035)
VALIDITY EDITS
2-035-01V
MUST BE ALPHA, 0, OR 5.
Relational Edits
NONE
ELEMENT NAME:  DATE TED RECORD PROCESSED TO COMPLETION (2-040)
VALIDITY EDITS
2-040-01V
MUST BE A VALID GREGORIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
2-040-01R
DATE TED RECORD PROCESSED TO COMPLETION (PTC) MUST BE ≤ BATCH/VOUCHER DATE
ELEMENT NAME:  DATE ADJUSTMENT IDENTIFIED (2-045)
VALIDITY EDITS
2-045-01V
MUST BE A VALID GREGORIAN DATE OR ALL ZEROES AND CANNOT BE > DHA CURRENT SYSTEM DATE.
2-045-02V
IF TYPE OF SUBMISSION =
D
DENIAL OR
I
INITIAL SUBMISSION OR
O
ZERO PAYMENT WITH 100% OHI/TPL OR
R
RESUBMISSION
THEN DATE ADJUSTMENT IDENTIFIED MUST BE ALL ZEROES.
2-045-04V
IF TYPE OF SUBMISSION =
A
ADJUSTMENT OR
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
C
COMPLETE CANCELLATION OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
THEN DATE OF ADJUSTMENT IDENTIFIED MUST BE A VALID GREGORIAN DATE
Relational Edits
2-045-03R
IF TYPE OF SUBMISSION =
A
ADJUSTMENT OR
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
C
COMPLETE CANCELLATION OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
THEN DATE ADJUSTMENT IDENTIFIED MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION AND ≥ FILING DATE
ELEMENT NAME:  PERSON IDENTIFIER (SPONSOR) (2-050)
VALIDITY EDITS
2-050-01V
MUST BE NINE NUMERIC DIGITS (CANNOT BE ALL ZEROES, ALL NINES, OR ALL BLANKS)
Relational Edits
NONE
ELEMENT NAME:  PERSON IDENTIFIER TYPE CODE (SPONSOR) (2-051)
VALIDITY EDITS
2-051-01V
MUST BE A VALID VALUE (REFER TO Section 2.7).
Relational Edits
NONE
ELEMENT NAME:  SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (2-055)
VALIDITY EDITS
2-055-01V
MUST BE A VALID SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (REFER TO Section 2.8).
Relational Edits
REFER TO Section 8.1.
ELEMENT NAME:  AGR SERVICE LEGAL AUTHORITY CODE (2-056)
VALIDITY EDITS
2-056-01V
MUST BE VALID AGR SERVICE LEGAL AUTHORITY CODE (REFER TO Section 2.4).
Relational Edits
REFER TO Section 8.1
ELEMENT NAME:  PERSON LAST NAME (PATIENT) (2-061)
VALIDITY EDITS
2-061-01V
MUST BE AT LEAST ONE CHARACTER (LEFT-JUSTIFIED).
Relational Edits
NONE
ELEMENT NAME:  PERSON FIRST NAME (PATIENT) (2-062)
VALIDITY EDITS
NONE
Relational Edits
NONE
ELEMENT NAME:  PERSON MIDDLE NAME (PATIENT) (2-063)
VALIDITY EDITS
NONE
Relational Edits
NONE
ELEMENT NAME:  PERSON CADENCY NAME (PATIENT) (2-064)
VALIDITY EDITS
NONE
Relational Edits
NONE
ELEMENT NAME:  PERSON IDENTIFIER (PATIENT) (2-065)
VALIDITY EDITS
2-065-01V
MUST BE NINE NUMERIC DIGITS AND CANNOT EQUAL ALL BLANKS.
Relational Edits
NONE
ELEMENT NAME:  PERSON IDENTIFIER TYPE CODE (PATIENT) (2-066)
VALIDITY EDITS
2-066-01V
MUST BE A VALID VALUE (REFER TO Section 2.7).
Relational Edits
NONE
ELEMENT NAME:  PERSON BIRTH CALENDAR DATE (PATIENT) (2-070)
1  PATIENT AGE IS CALCULATED BASED ON PERSON BIRTH CALENDAR DATE (PATIENT) AND BEGIN DATE OF CARE.
VALIDITY EDITS
2-070-01V
MUST BE VALID GREGORIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
2-070-01R
PATIENT AGE1 MUST BE < 125 YEARS
2-070-02R
PERSON BIRTH CALENDAR DATE (PATIENT) MUST BE ≤ BEGIN DATE OF CARE.
ELEMENT NAME:  DEERS DEPENDENT SUFFIX (2-075)
VALIDITY EDITS
2-075-01V
IF TYPE OF SERVICE (SECOND POSITION) =
M
MOP DRUGS, SUPPLIES, PRESCRIPTION AUTHORIZATIONS, AND REVIEWS
OR TYPE OF SUBMISSION =
B
ADJUSTMENT OF NON-TED RECORD (HCSR) DATA OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
THEN MUST BE A VALID DEERS DEPENDENT SUFFIX OR BLANK (REFER TO Section 2.4) OTHERWISE MUST BE BLANK
Relational Edits
NONE
ELEMENT NAME:  PATIENT IDENTIFIER (DoD) (2-080)
VALIDITY EDITS
2-080-01V
MUST NOT BE BLANK FILLED
2-080-02V
MUST NOT EQUAL ALL ZEROES
UNLESS TYPE OF SUBMISSION =
D
COMPLETE DENIAL TED RECORD DATA
OR ALL OCCURRENCES/LINE ITEMS CONTAIN AN ADJUSTMENT/DENIAL REASON CODE (REFER TO Addendum G, Figure 2.G-1 OR Figure 2.G-2).
AND THE TED RECORD CORRECTION INDICATOR =
1
ADJUSTMENT/CANCELLATION (TYPE OF SUBMISSION A, B, C, OR E) SOLELY TO CORRECT A PROVISIONALLY ACCEPTED TED RECORD OR
3
ADJUSTMENT/CANCELLATION (TYPE OF SUBMISSION A, B, C, OR E) TO CORRECT BOTH EDIT ERRORS ON A PROVISIONALLY ACCEPTED TED RECORD AND TO CORRECT CLAIM PROCESSING ERRORS OR UPDATE PRIOR DATA WITH MORE CURRENT/ACCURATE INFORMATION
Relational Edits
NONE
ELEMENT NAME:  DEERS IDENTIFIER (PATIENT) (2-082)
VALIDITY EDITS
2-082-01V
POSITIONS 10 AND 11 MUST BE NUMERIC
Relational Edits
NONE
ELEMENT NAME:  PERSON SEX (PATIENT) (2-085)
VALIDITY EDITS
2-085-01V
PERSON SEX (PATIENT) MUST =
F
FEMALE OR
M
MALE OR
Z
UNKNOWN
Relational Edits
NONE
ELEMENT NAME:  PATIENT ZIP CODE (2-090)
1  WHEN FOREIGN COUNTRY CODES ARE SUBMITTED, THE FIRST THREE CHARACTERS WILL BE EDITED AGAINST Addendum A.
VALIDITY EDITS
2-090-01V
MUST BE NINE DIGITS OR FIVE DIGITS WITH FOUR BLANKS
MUST BE A VALID ZIP CODE (BASED ON BEGIN DATE OF CARE) IN THE GOVERNMENT PROVIDED ELECTRONIC ZIP CODE FILE OR
MUST BE A THREE CHARACTER FOREIGN COUNTRY CODE (BASED ON THE COUNTRY CODES TABLE1) FOLLOWED BY SIX BLANKS
Relational Edits
NONE
ELEMENT NAME:  OVERRIDE CODE (2-095)
1   DATABASE: CONTRACT INFORMATION PROVIDED TO THE TED SYSTEM FROM THE DHA ACCOUNTING SYSTEM VIA CORAMS FILE.
VALIDITY EDITS
2-095-01V
OCCURRENCE NUMBER 1--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6)
2-095-02V
OCCURRENCE NUMBER 2--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6)
2-095-03V
OCCURRENCE NUMBER 3--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6)
2-095-04V
A VALUE CANNOT BE CODED MORE THAN ONCE (EXCEPT BLANK).
2-095-05V
ALL OCCURRENCES OF OVERRIDE CODE MUST BE BLANK FILLED FOLLOWING THE FIRST OCCURRENCE OF A BLANK FILLED OVERRIDE CODE.
Relational Edits
2-095-11R
IF ANY OCCURRENCE OF OVERRIDE CODE =
NC
NON-CERTIFIED PROVIDER (DOES NOT INCLUDE SANCTIONED/SUSPENDED PROVIDERS)
THEN ONE OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
AD
FOREIGN ACTIVE DUTY CLAIMS OR
AN
SHCP - NON-MTF/eMSM REFERRED CARE OR
AR
SHCP - MTF/eMSM REFERRED CARE OR
CE
SHCP - CCEP OR
EU
EMERGENCY SERVICES RENDERED BY AN UNAUTHORIZED PROVIDER OR
GU
SERVICE MEMBER ENROLLED IN TPR OR
MN
TSP - NETWORK OR
MS
TSP - NON-NETWORK OR
SC
SHCP - NON-TRICARE ELIGIBLE OR
SE
SHCP - TRICARE ELIGIBLE OR
SM
SHCP - EMERGENCY
OR ENROLLMENT/HEALTH PLAN CODE MUST =
SN
SHCP - NON-MTF/eMSM-REFERRED CARE OR
SR
SHCP - MTF/eMSM REFERRED CARE OR
SU
SHCP - REFERRAL DESIGNATION UNKNOWN
2-095-12R
IF ANY OCCURRENCE OF OVERRIDE CODE =
NP
PAYMENT TO PROVIDER, PHARMACY, ENTITY, OR CLIENT BENEFICIARY TEMPORARILY SUSPENDED AT DIRECTION OF DHA, PI
THEN BATCH/VOUCHER CLIN/ASAP ACCOUNT NUMBER ASAP DESCRIPTION FOUND IN DHA DATABASE1 MUST =
BA
BATCH
- END -
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